Initial treatment of temporomandibular disorder (TMD) in adults

* We provide education regarding the natural history of the condition and reassurance that, for most patients, TMD symptoms are self limiting and only a small minority develop chronic TMD. Self-care measures include application of heat and/or ice, optimal posture, relaxation techniques, jaw exercises, sleep hygiene, and avoidance of triggers (eg, tooth grinding, gum chewing, jaw clenching or posturing, wind instrument playing, nail biting, pen chewing, or other repetitive jaw activities).

¶ NSAIDs may not be appropriate in some patients, assess for age related, cardiovascular, or gastrointestinal risk factors. Alternatives include topical diclofenac and acetaminophen.

Δ The diagnosis should be reassessed in patients who have not had any improvement and the patient referred to an ears, nose, and throat (ENT) specialist. Patients with severe arthritis of the temporomandibular joint (TMJ) or persistent symptoms due to internal derangement and joint pathology may require interventional treatments.